Presented at The International Association of Emergency Managers (IAEM) 2010 Annual Conference with Nicole Errett, Baltimore City Mayor\'s Office of Emergency Management

1. Public Health 101 - What Every
Emergency Manager Needs to Know
International Association of Emergency Managers Conference
November 2nd, 2010
Nicole Errett
Baltimore City Mayor’s Office of Emergency Management
Brian Spendley
Hagerty Consulting
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2.  Define Public Health and its core concepts
 Describe the U.S. Public Health Preparedness
Infrastructure
 Discuss
 H1N1
 Identify funding opportunities
 Identify implications of PPACA (Health Reform) on
emergency planning assumptions
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3. Public Health Definition
Public Health definition and
prevention
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4.  “…assuring conditions in which people can be
healthy.”
 Goals (the three P’s)
 Prevent Disease
 Promote Health
 Prolong Life
 Two major defining characteristics
 Deals with prevention instead of curative aspects of health
 Focuses on population-level interventions, not individual
level
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5.  3 Core Functions
 Assessment
 Policy Development
 Assurance
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6.  Primary Prevention
 Prevent the outcome before it occurs (e.g. vaccination)
 Secondary Prevention
 Early detection (e.g. screenings)
 Tertiary Prevention
 Prevent the outcome from getting worse (e.g.
treatment)
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7.  Primary Prevention
 Prevent the outcome before it occurs (e.g. planning,
hazard mitigation, gap analysis, training and exercises)
 Secondary Prevention
 Early detection (e.g. surveillance)
 Tertiary Prevention
 Prevent the outcome from getting worse (e.g.
emergency management operations)
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8.  Undergraduate Degree Programs (BS, BA)
 Master Degree Programs (MS, MPH, MHS, ScM,
MHA)
 Doctoral Degree Programs (PhD, ScD, DrPH, MD
with residencies in preventative medicine)
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9.  You’re not alone!
 Most public health professionals in the United
States are not formally trained:
 Health department personnel
 Clinic workers
 Public health consultants
 Emergency managers
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10. Core Concepts
What are the major
components of a public
health education?
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11.  Biostatistics
 Epidemiology
 Health Policy and Management
 Environmental Health
 Social/Behavior Health Sciences
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12.  Creates and applies methods for quantitative
research in health sciences (JHSPH).
 Science of obtaining, analyzing and interpreting
data in order to understand and improve human
health (UNC).
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13.  How can we apply past incidents to accurately
predict future events?
 Statistical significance
 Methods
 Example: Baltimore City Code Red
 Does Energy Assistance Program enrollment correlate
with the impact of a Code Red day or a Code Red
season?
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14.  The study of the distribution and determinants of
health and disease in human populations to
enable health services to be planned rationally,
disease surveillance to be carried out, and
preventative and control programs to be
implemented and evaluated (World Health
Organization).
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15.  Identifying disease clusters and priority
populations
 Where are your vulnerable populations located?
 Example: H1N1
 Initial confusion over disease severity and mode of
transmission
 Strategically placing H1N1 – novel influenza
immunization clinics
 Quality assurance
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16.  Addresses all the physical, chemical, and biological
factors external to a person, and all the related
factors impacting behaviors. It encompasses the
assessment and control of those environmental
factors that can potentially affect health (World
Health Organization).
 Includes occupational health, risk assessment and
toxicology
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17.  Risk assessment and toxicology
 Hazard mitigation planning
 Risk = Probability * Severity
 Risk is relative
 Hospital Hazard Analysis (required by the Joint Commission)
takes advantage of Public Health risk assessment strategies
 HAZMAT
 PPE
 Building materials
 Implications of 9/11 on air quality
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18.  Health policy
 Study of the policy process as it related to health
 Identify the problem
 Determine magnitude
 Analyze the problem
 Propose solutions
 Evaluate solutions
 Health management
 Study of health administration and leadership,
including application of quality assurance and
leadership strategies to the health arena
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19.  Policies
 PAHPA
 NHHS
 PPACA
 Emergency Plans
 Quality Assurance and Improvement
 HSEEP compliance
 Grant guidance
 Training and exercises
 Management
 NIMS
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20.  Addresses the behavioral, social and cultural
factors related to individual and population health
and health disparities over the life course. (ASPH)
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21.  Health communications
 How do we get people to listen to us?
 Preparedness planning, immunizations, evacuations
 Health Belief Model
 Cues to actions, perceived barriers
 Theory of Reasoned Action
 Behavioral intention is the most important predictor of
actual behavior
 How can we change that?
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22. Public Health in the United States
Research, Practice, and
Infrastructure
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23.  Where is public health researched?
 Academia
 Schools of Public Health
 “Community Health”
 Health departments
 Private and Public Sector
 Where is public health practiced?
 Health departments and agencies
 Emergency management offices and agencies
 Government agencies
 Private Sector
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24.  What is the foundation?
 Pandemic and All Hazards Preparedness Act (PAHPA)
 National Health Security Strategy (NHSS)
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25.  The purpose of the Pandemic and All-Hazards
Preparedness Act is to “improve the Nation’s
public health and medical preparedness and
response capabilities for emergencies, whether
deliberate, accidental, or natural.
 Ratified in December 2006.
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26.  Amended the Public Health Service Act to
establish a new Assistant Secretary for
Preparedness and Response (ASPR)
 Called for a quadrennial National Health Security
Strategy (NHSS)
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27.  Major Program Areas
 Biomedical Advanced Research and Development Authority
(BARDA) and Medical Countermeasures
 Emergency Support Function (ESF) #8: Public Health and
Medical Response: Domestic Programs
 Emergency Support Function (ESF) #8: Public Health and
Medical Response: International Programs
 Grants
 At-Risk Individuals
 National Health Security Strategy (NHSS)
 Situational Awareness: Surveillance, Credentialing, and
Telehealth
 Education and Training
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28.  What is it?
 National Health Security is a state in which the nation and its
people are prepared for, protected from, and resilient in the
face of health threats with potentially negative
consequences.
 Two Goals
 Build community resilience
 Strengthen and sustain health and emergency response
systems.
 No unfunded mandates; aligns with the NRF and NSS.
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29.  Department of Health and Human Services
(DHHS)
 Food and Drug Administration (FDA)
 National Institute of Health (NIH)
 Assistant Secretary for Preparedness and Response
(ASPR)
 Center for Disease Control and Prevention (CDC)
 Environmental Protection Agency (EPA)
 Department of Homeland Security (DHS)
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30.  Created under PAHPA
 Lead the nation in preventing, preparing for, and
responding to the adverse health effects of public
health emergencies and disasters.
 Focus:
 Preparedness planning and response;
 Building federal emergency medical operational capabilities;
 Countermeasures research, advance development, and
procurement;
 Grants to strengthen capabilities of hospitals and health care
systems in public health emergencies and medical disasters.
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31.  Mission: Collaborating to create the expertise,
information, and tools that people and
communities need to protect their health –
through health promotion, prevention of disease,
injury and disability, and preparedness for new
health threats.
 emergency.cdc.gov
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32.  WIDELY varied structures and authorities
 ME: 5 state agencies, 2 city health departments, 5 tribal
agencies, 492 municipal health officers
 MA: 6 state agencies, 1 county health department, 4
regional health districts, 351 municipal boards of health
 NY: 2 state agencies, 58 city/county health departments
 MD: 6 state agencies, 24 local county health
departments
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33. Discussion
H1N1 Novel Influenza
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34. Now show me the money!
Federal grant opportunities in
emergency management and
public health preparedness
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35.  Federal Funding
 Fiscal Year (October 1st – September 30th)
 Funding announcements can occur at any time
throughout the fiscal year and often notifications to the
State Single Point of Contact (SPOC)
 Two forms:
 Discretionary Grants
 Formula / Block Grants
 Approval can take 3-9 months
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36.  Department of Homeland Security
 FEMA Administered
 Health and Human Services
 ASPR
 CDC
 Department of Defense (limited PH impact)
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37.  American Recovery & Reinvestment Act (ARRA)
 Buffer Zone Protection Program (BZPP)
 Citizen Corps Program National Emergency Technology Guard (NET Guard) Pilot Program
 Commercial Equipment Direct Assistance Program (CEDAP)
 Competitive Training Grants Program (CTGP)
 Driver's License Security Grant Program (DLSGP)
 Emergency Management Performance Grant (EMPG)
 Emergency Operations Center (EOC) Grant Program
 Freight Rail Security Grant Program (FRSGP)
 Homeland Security Grant Program (HSGP)
 Interoperable Emergency Communications Grant Program (IECGP)
 Intercity Passenger Rail (Amtrak)
 Intercity Bus Security Grant Program (IBSGP)
 Nonprofit Security Grant Program (NSGP)
 Port Security Grant Program (PSGP)
 Regional Catastrophic Preparedness Grant Program (RCPGP)
 Tribal Homeland Security Grant Program
 Transit Security Grant Program (TSGP)
3  Trucking Security Program (TSP)
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38.  Purpose: to assist state and local governments in
enhancing and sustaining all-hazards emergency
management capabilities
 State Administrative Agency (SAA) or State’s EMA
are eligible to apply
 FY 2010: $329.8 Million
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39.  Purpose: to build capabilities at state and local levels
and to implement goals/objectives in state homeland
security strategies and initiatives in State Homeland
Security Preparedness Report
 25% dedicated towards law enforcement terrorism
prevention
 Funds allocated based on
 Minimum amounts legislatively mandated
 Risk Methodology
 Effectiveness
 FY 2010: $842 Million
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40.  Purpose: enhance regional preparedness in 64
major metropolitan areas
 25% dedicated towards law enforcement terrorism
prevention
 FY 2010: $823.5 million
 10 highest risk (Tier I) eligible for $524,487,600
 Remaining 53 (Tier II) eligible for $308,032,400
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41.  Purpose: Supports integration of emergency
management, health, and medical systems into a
coordinated response to all hazard mass casualty
incidents
 Augmented existing local operational response
systems before the incident occurs
 124 MMRS jurisdictions
 FY 2010: $39.36 Million
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42.  Purpose: bring community and government
leaders together to coordinate community
involvement in emergency preparedness,
planning, mitigation, response and recovery.
 FY 2010: $12.48 Million
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43.  Purpose: support target-hardening activities to
nonprofit organizations that are at high risk of a
terrorist attack and are located within one of the
UASI areas
 Funds based on risk analysis, effectiveness, and
integration
 FY 2010: $19 Million
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44.  Purpose: Enhance catastrophic incident
preparedness in 11 high risk areas, support
regional coordination, including development of
plans, protocols and procedures, and share
deliverables
 FY 2010: $33.6 Million
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45.  Purpose: provides funding directly to help eligible
tribes prepare for risks associated with potential
terrorist attacks
 FY 2010: up to $10 Million
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46.  Public Health Emergency Preparedness Program
(PHEP)
 Hospital Preparedness Program (HPP)
 Preparedness and Emergency Response Research
Center (PERRC)
 Centers for Public Health Preparedness (CPHP)
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47.  Nearly 85% of CDC budget goes towards
grants/contracts
 Awards ~$7 Billion annually
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48.  Purpose: to support preparedness capability and
capacity in state, local, tribal and public health
departments
 FY 2010: $690,259,211
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49.  Purpose: support and enhance state and local public health
preparedness and response infrastructure
 Goals
 Strengthen and sustain PH workforce
 Increase lab capability and capacity
 Strengthen disease surveillance activities
 Plan/implement mass vaccination
 Develop effective risk communication
 Develop effective communication mitigation
 Purchase/protect PPE, antivirals and pandemic supplies for Public Health
workforce
 Train/educate Public Health workforce
 Address gaps, meet challenges of PH preparedness
 New vaccination program guidance introduced September, 2010
 To date: $1.35 Billion through 4 phases
 CDC Administered
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50.  Purpose: enhance ability of hospitals/health care
systems to prepare for and respond to
bioterrorism and other public health emergencies
 Administered by ASPR
 FY 2010: $390,500,000
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51.  Administered by CDC to accredited Schools of
Public Health
 PERRC includes research projects; many schools
apply to practice oriented research projects
 CPHP are training oriented grants. Most trainings
are open to State/local EM and PH
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52. Health Reform: Patient Protection and
Affordable Care Act (PPACA)
What is it?
How does it affect planning
assumptions?
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53.  Individual Mandate
 By 2014, all Americans must have health insurance
 $695 or 2.5% household income fine
 Exceptions for financial hardship (income to cost ratio
>8%, earn too little pay for federal income tax, religious
objections, Native Americans, uninsured <3 months)
 Employer Mandate
 Employer with 50 or more employees must provide
minimum coverage or pay penalty
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54.  Health Insurance Exchange
 Subsidies
 Transparency
 Medicaid Expansion
 133% Federal Poverty Line
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55.  Minimum Coverage
 Cannot deny coverage for pre-existing conditions
 No lifetime caps on benefits allowed
 Preventative services are not subject to co-pay and
deductibles
 Mental health parity
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56.  Reduces uninsured by 32 million in 2019 (CBO
Estimate)
 Illegal aliens, individuals who think they cannot afford
the cost even with the subsidy, and those that would
rather pay the penalty remain uncovered
 Decreases vulnerability
 May decrease cost
 Increases transparency
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57. Questions?
Nicole Errett
nicole.errett@baltimorecity.gov
Baltimore City Mayor’s Office of Emergency Management
Brian Spendley
brian.spendley@hagertyconsulting.com
Hagerty Consulting
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